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Comparing different patterns for managing febrile children in the ED between emergency and pediatric physicians:

Vei-Ken Seow1, Aming Chor-Ming Lin, I-Yin Lin

  • 1Emergency Department, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei 111, Taiwan.

The American Journal of Emergency Medicine
|November 21, 2007
PubMed

Insights

Pediatric physicians (PPs) showed higher guideline compliance for children with fever of unknown origin than emergency physicians (EPs), leading to fewer revisits but similar admission rates. This impacts pediatric fever management in emergency departments.

Area of Science:

  • Pediatric Emergency Medicine
  • Clinical Practice Guidelines
  • Fever Management

Background:

  • Management of pediatric fever of unknown origin in emergency departments (EDs) lacks standardized practice.
  • Variations exist in how pediatric physicians (PPs) and emergency physicians (EPs) manage these cases.
  • Existing practice guidelines aim to standardize care and improve patient outcomes.

Purpose of the Study:

  • To compare practice patterns of PPs and EPs in managing pediatric fever of unknown origin in the ED.
  • To correlate these practices with existing clinical guidelines.
  • To evaluate the impact of different management strategies on patient outcomes.

Main Methods:

  • Retrospective review of medical records for children (3-36 months) with fever of unknown origin.
  • Telephone follow-up to assess subsequent healthcare utilization.
  • Comparison of laboratory tests, ED length of stay (LOS), admission rates, and unscheduled revisits between PPs and EPs.
  • Evaluation of guideline compliance based on patient presentation (toxic appearance, fever severity).

Main Results:

  • Pediatric physicians admitted more toxic-appearing children and had fewer unscheduled revisits compared to EPs.
  • For febrile children, PPs ordered more lab tests and had longer ED LOS but similar revisit rates.
  • PPs admitted more non-toxic febrile children and ordered more tests, with longer ED LOS but no difference in revisit rates.
  • Subsequent admission rates were similar across all groups and between physician types.

Conclusions:

  • Pediatric physicians demonstrated higher adherence to practice guidelines for pediatric fever management.
  • Higher guideline compliance by PPs correlated with a reduced rate of unscheduled revisits.
  • No significant difference in subsequent admission rates was observed between PPs and EPs.
Abstract

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